Doctors Question Use Of Antibody Testing As Pressure To Reopen Idaho Mounts

Apr 22, 2020

 

We’re back again this week with our panel of Idaho doctors to answer more of your COVID-19 questions. From antibody testing to questions about when to reopen the state, Idaho Matters is here to help get your questions answered. 

Joining Idaho Matters this week to share their expertise are:

  • Dr. David Pate, part of the governor’s Coronavirus Task Force, and former CEO of St. Luke’s 
  • Dr. Jim Souza, St. Luke’s Health System Chief Medical Officer
  • Dr. Andrew Southard, Saint Alphonsus Emergency Medical Director

Have a question for the panel? Leave us a voicemail with your question and we may use it on next Wednesday’s show. Here’s the number to call: 208-426-3625.

Read the full interview here:

GEMMA GAUDETTE: You're listening to Idaho Matters. I'm Gemma Gaudette. As we continue to cover the coronavirus pandemic, we know that so many of you have questions, you have concerns. And here at Idaho Matters, we want to answer those questions with facts and we feel the best way to do that is to bring in Idaho medical experts. We've been doing this every Wednesday for the last few weeks, where we bring in a panel of doctors and other health professionals to get us updated to answer those questions. If you're a regular listener, think of this as like our doctor's version of that Friday Reporter Roundtable. So joining us today are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce. Dr. Andrew Southard, Saint Alphonsus emergency medical director, and Dr. Jim Souza, St. Luke's chief medical officer. Thanks all for being here today.

ALL: Thank you. Hi Gemma.

GAUDETTE: Hey, Dr. Pate, I just start with you. What is the latest with the Governor's Coronavirus Taskforce? Because we got that extension last week to April 30th. And where are we right now with that?

DR. DAVID PATE: Well, it's surprising how fast two weeks can go by. And, you know, we are we are continuing to look closely at the data. Obviously, if there's going to be any consideration to changing the last iteration of the governor's order, we want to make sure that we are well on top of what is happening in Idaho. And we're reviewing that data very carefully. Also, we are focusing on three key things: One is testing. And in fact, there is a Testing Task Force being set up this week that will report to the workgroup. So that will be very helpful. There's a lot of misunderstanding out there about testing. And I think having a group of experts advising and providing guidance for the state will be extremely helpful. Another thing we're focusing on is contact tracing and making sure that if we do have new cases, we're readily able to identify others who might, and can isolate them. And then finally, search capacity, because if there is to be any further loosening up, you just want to make sure that health care providers are prepared to deal with whatever increases we might see. Finally, we now have the White House Plan for Reopening America. And so we're looking at that very closely and determining how does that relate to our own Idaho plan and how does that fit together. So we're pretty busy.

GAUDETTE: Yeah, you are. I want to get back to that in a moment about the reopening. But first, Dr. Souza, St. Luke's, if I read this correctly, change some of its drive-up tent screening times this week. So why? And is that a good sign that something like that is happening?

DR. JIM SOUZA: Thanks for the question. Yes, we did change our tent testing times. And I do think it's a good sign. The decision was made because the demand, frankly, is continuing to go down. We have seen steady decreases kind of week by week. So if you go back to just two or three weeks ago, we were saying, you know, six, seven, eight hundred a day type numbers and we're now down around the one hundred or less per day type numbers. So it is a sign that the steps taken by the governor are actually working. 

GAUDETTE: And Dr. Southard, what's going on in your emergency room? And I have a couple of questions about that: Are you seeing a lot of people still coming in with symptoms that could be the coronavirus? And then also, are you seeing less people come in for other types of injuries or issues that would normally bring them into an emergency room?

DR. ANDREW SOUTHARD: Yeah. You really just nailed it on the head there because we are seeing still quite a few people with symptoms that could be related to COVID, but like Dr. Souza said, it has decreased. I would say especially in the last week or so, we're starting to see fewer... Our numbers across the board -- and this is not just here locally, it's national as well -- of emergency departments are down about 30 percent in our volume. And so one of the big concerns that we have as emergency providers is, are people now scared to come to the emergency department because they think they're gonna get coronavirus. And are they staying at home with these disease processes like a stroke or heart attack that are going to be detrimental to their health long term? And I don't know the answer to that. I suspect that it's partly true. And we are starting to see a little bit more of the percentage of people coming in with non-COVID complaints increase, which is not a good sign because people are sick, which is a good sign because people are willing to come to the hospital again.

GAUDETTE: Well, and I asked the question about the emergency room for the fact that, like I'm a mom, I have two boys. And there has been so many things coming out of my mouth lately about like, do not climb on that, don't get too close to that. We can not go to the E.R. right now. And I mean, not to not to make light of that, but there is this feeling of, A) we don't want to go to the emergency room because of people that are going in with symptoms, but also we don't want to overwhelm the emergency room, if people need to go there who may have symptoms.

DR. SOUTHARD: Yeah. That was initially, I think, the biggest fear in emergency medicine a month and a half, two months ago was we were going to be overwhelmed with patients seeking testing or worried. Well, that never really occurred because, quite frankly, the general public took it to heart and really paid attention to their symptoms and what we were telling [them] to do. And so that didn't occur. And then we were really quite concerned about having a a big surge like New York City did. And because of the steps that the governor took and the public took, that really didn't occur either. So we were pretty effective. And we do have capacity now. I think people should realize that in our emergency department and all the emergency departments here in the Valley, I guess, the procedure for taking patients and the triage really helps segregate those who are going to have COVID symptoms or not. And it's it is safe to come to the emergency department. I want people to know that if you are in an accident, if you need, you know, your broken arm or leg or you're cut, sewn up, you will be safe in our emergency departments. I go to work there a couple of times a week and I've not been sick. We take a lot of precautions. So I don't want there to be a general fear of that. And hopefully you can overcome that.

GAUDETTE: Well, I appreciate that. So a question for all of you. And Dr. Pate mentioned things that, you know, getting into place about, about potentially reopening the country, reopening the economy. I would love your opinions as to are we ready to reopen or can you even make that statement yet? And why don't I just start with Dr. Pate. We'll go down the line. Dr. Pate, Dr. Souza, and Dr. Southard.

DR. PATE: Thanks, Gemma. This is a great question and obviously it's on everybody's minds. I don't know that we're ready today, but we likely are going to be ready soon. I think the things that put us in a very good opportunity to even have this discussion is the fact that our newly confirmed cases are clearly on the decline. It looks like we hit our peak and I'll just qualify -- I'm referring to the first peak, I suspect there'll be more -- but we hit our peak around April 2nd, and then we've seen a really nice trend down from there. That's been sustained. And you want to... You know, I think that governor is very wise when he thinks about looking at these things in a two week increment, because it's about that amount of time for you to kind of assess how what what direction are things really moving in. So we've got some pretty good evidence. We're definitely headed in the right direction. I think the other thing is the compliance with social distancing because of everything that we have available today to combat this virus. There is nothing more successful than social distancing, hand-washing, all the things we've been talking about. It works and our early models were based on assuming 50 percent compliance. It appears we're actually getting somewhere around 67 percent compliance in the state, which is really good, like Dr. Souza and Dr. Southard mentioned, and that is helping to drive these cases down. So as we make plans to open up, you know, this is going to be new territory for us. And so we have to watch it very carefully. So what you want to be prepared to do is readily test people that come down with symptoms. And frankly, this is going to give a little bit easier because it's been so confusing in the last three months because we've had influenza, RSV, lots of other cold and flu viruses. Those are going to be starting to trend down soon and it's going to be more likely if you have respiratory symptoms that maybe it really is COVID. So we want to rapidly test, then we want to be able to contact-trace and make sure that we can identify all the people that that person might have accidentally infected. And then I think we want to make sure that we have good reporting and monitoring so that if we start to see an uptick in cases, we'll know it and we can act on that early. And I think lastly, you want to make sure that you have plenty of hospital capacity. Back to the point. Dr. Southard made about, you know, we don't want to overwhelm the health care providers, but the number of cases -- because we've waited to this extent -- the number of cases in our hospitals has gone way down. So we're in a much better position.

GAUDETTE: Dr. Souza and Dr. Southard other, do either of you want to add into that? 

DR. SOUZA: I'd only add one thing to what Dr. Pate was suggesting, in addition to the testing and probably, frankly, expanding the criteria for testing to any folks with symptoms and contract tracing and isolation. We have to identify the at-risk population. Keep them in place, protect them and even be more aggressive with them. Because what we've learned with this pandemic is not exclusively, but to a very large extent, that will be the population that will be filling our intensive care units and needing mechanical ventilation and in high level care. So we have to think about them in a more focused or surgical way rather than just kind of a blanket stay at home order.

DR. SOUTHARD: And I would just say, Gemma, that I think people, if they can continue to be patient, even if we decide April 30th, we're reopening, etc. or whatever the date ends up being. It's not like COVID decides to go away at that point. It's still out there. And so people need to continue to do the commonsense things: washing their hands. You know, it's probably not the time to have your big family reunion May 1st. And, you know, if you are feeling sick, don't go into work. I think we have to push that a little bit harder in the post-COVID world, of if people have symptoms of things that you might have before just gone in and kind of toughed it out, it's probably not the right thing to do. You don't want to get your co-workers sick. So that's a little bit what I would say as well.

GAUDETTE: We're gonna take a quick break, we're gonna come back with our medical experts and we have quite a few listener questions that we want to get to next. This is Idaho Matters. 

GAUDETTE: Continuing Idaho Matters right now and continuing our conversation with our medical experts today as they answer your questions about the coronavirus. Our panel, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Taskforce, Dr. Andrew Southard, he is St. Alphonsus emergency medical director and Dr. Jim Souza, St. Luke's chief medical officer. The first question we have is a call from a listener asking if Boise's Veterans Hospital is requiring space mats for people going inside.

LISTENER QUESTION: I'm a construction worker and I work in a lot of the hospitals in town. So as far as I know, the two big hospital, St. Luke's and St. Al's are requiring everybody that goes inside to wear a face covering of some kind, whether you are a visitor, an employee or a patient or a contractor. The V.A. is not requiring that. And I'm just curious why that is. And that's the V.A. in Boise. And that's my question.

GAUDETTE: We did talk with Josh Callahan, he is the public affairs officer at the Boise V.A. Medical Center, and he said, and this is a quote, "The center will be implementing a requirement to have all staff wear face masks starting this Friday, April 24th. Starting Friday, we will be distributing masks and communicating the details of the requirements to staff." So Dr. Souza and Dr. Southard, what are the requirements around face masks at St. Al's and St. Luke's?

DR. SOUZA: Yeah, we have a universal of face-masking policy for all staff working in clinical areas. I'll let Dr. Southard talk about St. Al's. And we're encouraging mask use by any visitors as well.

DR. SOUTHARD: Yeah, and that's essentially the same thing at St. Al's. We're distributing masks to people. We have a pretty restricted visitor policy at this point just to decrease exposure risk to everyone and they're offered masks when they come in. So everyone you see is basically going to be wearing masks at St. Al's now.

GAUDETTE: In your opinion, how important is it that people wear, you know, masks, and even the homemade type when, they're out and about, like, let's say, going to the grocery store? I'm certainly seeing more people complying with that.

DR. PATE: You know, Gemma, this David Pate. I was just going to say that, you know, to it this sounds a little counterintuitive, but for your listeners to understand, wearing the mask or the face covering is not to protect you is to protect others. And the reason for the concern is that with this particular virus, it is possible to be shedding the virus and spreading it to others, even if you feel perfectly well. So if we have everybody wear face coverings, then what's going to happen is those large droplets that come out when you talk, cough or sneeze are hopefully going to get caught by your cloth mask or whatever you're wearing there to help make sure it doesn't get projected in the air, just someone standing nearby. Or that it comes out and lands on countertops or banisters or elevator buttons or other things that other people are going to touch.

GAUDETTE: I think that's really good to clarify that because it has been difficult to fully understand the implementation of that, so I really appreciate that clarification. I want to get to another listener question. This individual had a question from Twin Falls about not allowing clergy into St. Luke's and other hospitals during the pandemic for things like last rites.

LISTENER QUESTION: This Father Joseph Lustig, I'm one of the Catholic priests down in Twin Falls. And I was reading the Idaho Matters thing kind of looking for more information on admitting clergy, particularly Catholic priests who have essential service for our congregants at hospitals, especially at end of life. St. Luke's Magic Valley doesn't permit any clergy outside of their staff into their hospital and I trying to get the ball rolling. And I think a question like maybe we need to reassess what clergy are essential for our hospitals, especially the St. Luke's system, which is the only system here in the Magic Valley. When we have people end of life in our congregations throughout the whole of Magic Valley, at least once every two weeks, if not every week, someone is dying and looking for the sacraments, last rites, the end of life, sacraments that The Catholic Church offers. So that might be a great question to ask and as I keep researching into that... Bye bye.

GAUDETTE: Dr. Souza, can you talk a little bit more about that in particular since you asked particularly about St. Luke's in the Magic Valley?

DR. SOUZA: Absolutely. That's a tough question and a sensitive topic. You know, at this time, our clergy are treated the same as other visitors. And as you heard from Dr. Southard there, we are very restrictive visitor policies at this time. I think in the last time I was on this program, I had a question about, you know, visitors to a child and we were allowing one parent. We have an exception for laboring moms, but we're being very restrictive and we're doing that in the name of community health, public health. And a lot of this is actually informed by the data that's emerging just in the past week, out of Stanford, looking at Santa Clara County, Los Angeles, Boston, New Jersey. And as I've said in other interviews, the rate of acquisition of knowledge scientifically about this is stunning. But just in the past week, it's become more apparent that we have seriously underestimated potentially the size of the asymptomatic people who are infected in the community and are shedding virus. And we wouldn't want anyone to come into, you know, the room of a COVID patient, acquire the infection, perhaps because they're not adept at use of PPE and whatnot, and then unknowingly spread it to other older people in the community who then are a very high risk to not only get sick, but actually die. We're using technology to support clergy and family in visitation, whether it's Skype or FaceTime or Zoom. And the other thing that we offer is that our chaplains are working closely with clergy in all of our communities because our chaplains are trained in donning and doffing PPE and doing it really well. And they can kind of be that bridge between the local clergy member and the patient who's in the room.

GAUDETTE: Well, and I would say that, I mean, within the Catholic Church, you know, with the last rites, one of the seven sacraments there is oil that's given within the last rites. But we also, as you said, notices that we have technology where maybe there has to be more conversation. Right. About maybe having a priest on a FaceTime call and maybe a family member using the oil. I mean, you know, is it those conversations, too? I mean, we're in a totally different world now and we have to start thinking outside of the box.

DR. SOUZA: Yeah. I would only add that in many religions, sacraments at the end of life are very tactile human events. And this fact that we're needing to take this action in the name of public safety, it's only one of the sad outcomes that that has come from this pandemic. Now, you know, there's the silver lining as we're learning better how to use technology in any number of ways. But I acknowledge the disconnect.

GAUDETTE: I want to get to a question from Gia, listener Gia. She says, say our children are asymptomatic and never show symptoms, but have actually had coronavirus. Could a genetic component then make a parent asymptomatic or also never show symptoms?

DR. SOUTHARD: So Gemma, this is Dr. Southard. I think that this is actually one of the most fascinating medical aspects of the coronavirus disease. Why are some people asymptomatic and why are some people getting these horrible immune reactions in ARDS (acute respiratory distress syndrome)? And there absolutely is going to be some sort of genetic component to our immune system that's causing this. So I think her question is basically, if our kids are asymptomatic, are we more likely to be asymptomatic? We don't know that. But I do think it's possible your child could be very symptomatic and you might see one parent have a bad response to the disease and the other have a very mild course of the disease. And that's probably going to be genetically related.

GAUDETTE: Well, and seen that in certain big name people that have gotten something, Chris Cuomo with CNN has had a very difficult case. I mean, still consider mild, he wasn't hospitalized, but his wife barely had any symptoms at all. And this is within the same family, but two different, you know, genetic factors going on there. This is really fascinating. And I mean, Dr. Pate, is that some of you know, what is so rapidly happening with this. Right, it seems like every day you all in the medical profession are learning something new.

DR. PATE: Oh, yeah. What Dr. Souza said is absolutely true. Our our medical knowledge has been exploding. But even by looking at the history of our growth in medical knowledge lately, the knowledge about this brand new virus is staggering. How much we're learning, how fast we're learning. And so it is a lot. You know, I would say, you know, the genetic aspect to either our risk of getting infected or our risk of getting severe disease if we do get infected is a very, very interesting question and it's going to be a while till we have that answer, but is being actively looked at. But I would also tell you that I doubt that there's going to be one simple explanation. My guess is that this is going to be multi-factorial. For example, I think we've seen repeatedly that health care workers may have a higher propensity to get severe disease. And we think part of this could be what's the amount of viral load you get exposed to? So that could be a factor and in a different families, there might be different degrees of contact and interaction. So, you know, my guess is it's not one simple answer. The genetic question is fascinating. But my guess is it will be a whole host of factors. We're seeing something that suggests maybe there's some gender differences and that maybe women have some protective factors. We certainly see the difference in general between how kids react to this versus adults. We have seen particularly severe disease in minorities and low-income people. And, you know, that could be various social issues and not necessarily genetic. My guess is it's a whole constellation of factors that are going to decide if you get sick and how bad you get sick.

GAUDETTE: So speaking of that, when we are seeing things like certain minority groups getting hit harder, you know, could it be a socioeconomic issue as well when we when we look at these these clusters. And my question, would we be then with the antibody testing? There is going to be a news conference today here in Idaho, four o'clock talking about what they have been able to find out with Crush The Curve Idaho doing the antibody testing. They're also doing, you know, COVID-19 testing for anyone. So, I mean, we are at least getting more testing in that. My question is, when you have to, like drive, let's say first off, just to go get this antibody test. And so that is this a certain part of the population. And you have to pay for the test because it's not covered right now by insurance. Can that skew the numbers? And I want to know that because people are antsy. There are a lot of people you know, people are starting to protest. People want to get out. They want the economy to reopen. Can this give us a false sense of security with the antibody testing?

DR. PATE: Well, this is David Pate. All right. Well, then Dr. Souza can correct everything that I say wrong. But I will tell you, I've been very outspoken about this. And Gemma, I think your question reflects a great deal of sophistication and understanding that unfortunately we're not hearing in this debate. You're absolutely correct. So if you want to do an antibody test, that's great. My question is, what are you going to do with it? And some people think I'm either anti-doing antibody testing, which is not true, or they believe that I think we shouldn't do antibody testing until we have a perfect antibody test. Also, not true. What my position is, is that the role for antibody testing today is what Dr. Souza referred to those epidemiologic studies where we want to look at a population of people and try to get a better idea of how much of that population has been infected. And let's be clear, infected is not synonymous with immune, necessarily. We don't know. And so I'm all in favor of it if we want to do it as an epidemiologic study. But to your point, Gemma, if that's what Crush the Curve is trying to do is some kind of epidemiologic study, this is not how you do it, because you're absolutely right. You're getting a very select population when you charge $105 and there are two geography constraints. What we need is a well-constructed scientific study where we go out and assess the state of how many Idahoans have likely been infected. My special concern has been, since it's been touted as a way to get people back to work, this is alarming to me. Unfortunately, even if the test is as good as it has been touted, given what we think is the level of infection in Idaho and I'm talking about what Dr. Souza just revealed in this past week, some of the shocking numbers that maybe the number of people infected could be 20, 50 or even 80 times the number of confirmed cases, even if you took 80 times the confirmed number of cases in Idaho, which a few people really believe is that high, we would still be in a position where less than 10 percent of our population has been infected. And when you take even a good test, but you test people that are very unlikely to have the condition, you are going to end up with false positives. The good news is if you get a negative antibody test, I feel pretty confident about you relying that, OK, you did not have COVID and you are still susceptible. But if you get a positive test, I'm going to flip a coin as to whether you truly have been infected. And then it's not even that good at this point to be able to make a prediction about whether you're immune. So that I got off my soapbox, I'll let Dr. Souza straighten out everything I said wrong.

DR. SOUZA: Are we good get on time, Gemma?

GAUDETTE: You know what, we are running out of time, actually. But did you want to add anything to that, Dr. Souza?

DR. SOUZA: Just very briefly, I think testing will inform policy decisions. And Dr. Pate is right that we have to admit the limits of antibody testing. You know, we don't know how long positive antibodies stay. We don't know if they're protected. We don't know if it means you're not infectious. So if we're totally honest about it, drawing firm conclusions about antibody testing is speculative. But I do think that our civic leaders and our medical leaders and our business leaders are now in the position that we're we're going to have to start being ready to speculate, if you will, not making it up, but based on the best directionally correct data that we can we can pull together. And the last thing is just is re-emphasizing a point I made. Things are developing so quickly, some of the newer tests available just in the last week have made substantial improvements in sensitivity and specificity as that continues to happen in the weeks ahead. I think this conversation matures, becomes more ready for prime time and links in with our policymakers.

GAUDETTE: I want to thank all three of you for coming in today. This information is so critically important. And to get it from the medical experts, those of you on the frontlines, those of you on our taskforce, I think it makes such a difference. Thank you, Dr. Pate, Dr. Souza, and Dr. Southard, this is Idaho Matters.

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